Guidelines for Distinguishing Influenza-Like Illness from Inhalational Anthrax
This notice provides guidelines on the clinical evaluation of persons who are not known to be at increased risk for anthrax, but who have
symptoms of influenza-like illness. The notice includes a table of the "Symptoms and signs of patients with inhalational anthrax,
influenza, and non-influenza-like illness".

Interim Guidelines for Investigation of and Response to Bacillus Anthracis Exposures
The notice includes information on environmental sampling, nasal swabs, and antimicrobial therapy.

Synopsis for November 9, 2001

Update: Investigation of Bioterrorism-Related Anthrax, Adverse Events from Antimicrobial Prophylaxis, and Interim
Recommendations for Prevention and Control of Inhalational Anthrax

CDC and state and local public health agencies are continuing epidemiologic and laboratory investigations of bioterrorism-related anthrax.

PRESS CONTACT:
Division of Media Relations

CDC, Office of Communication(404) 6393286

Since the last report, one new case of confirmed cutaneous anthrax has been identified in a media company employee resulting from exposure to a
previously known contaminated letter. The probable source of exposure for two cases reported last week (one cutaneous and one inhalational) has
yet to be determined. Although these two cases ultimately might be attributed to letter handling, the lack of a discernable link to previous
cases or workplaces raises the possibility of new routes of exposure or new target populations.

Careful planning and implementation of a difficult nationwide adult mass campaign may result in the elimination of rubella in Costa Rica.

PRESS CONTACT:
Gina Tambini, M.D.

Pan American Health Organization(202) 9743706

Costa Rica has recently strengthened the measles eradication program and has adopted the goal to eliminate rubella and congenital rubella
syndrome (CRS) by implementing a successful adult vaccination campaign with measles-rubella vaccine. The target group (men and women aged 15-39
years) was chosen based on the epidemiology of rubella, and a serosurvey conducted in 1999 showing the age groups at risk. Over 1,600,000 (98%
of the target population) persons were immunized in a period of 1 month using different strategies at health units and convenient locations that
included, malls, universities, work places and house-to-house. Excellent cooperation between the Ministry of Health, the Ministries of Education
and Labor, workers unions, religious and community leaders, students federations, entrepreneurs, local government and the media played an
important role in the success of the campaign.

State Medicaid Coverage for Tobacco-Dependence Treatments  United States, 1998 and 2000

Medicaid enrollees in 17 states are not being provided with coverage for tobacco dependence treatment according to a new study by the University
of California, Berkeley, and CDC. The study also found that among the 33 states and the District of Columbia that did provide such coverage to
its Medicaid recipients, only Oregon offered all of the treatments recommended in the 2000 Public Health Service Clinical Practice Guideline on
Treating Tobacco Use and Dependence. States were more likely to cover some prescription drugs than over-the-counter medications for tobacco
dependence treatments (31 states versus 23 states). Only 13 states offered overage for any counseling services. Currently, 36 percent (11.5
million) of Medicaid enrollees smoke cigarettes. Medicaid recipients have a smoking prevalence 50 percent greater than the overall U.S.
population.

The report summarizes surveillance data for West Nile Virus (WNV) activities in the United States. The report includes
information on human cases and deaths, infected birds and other animals, and WNV-positive mosquito pools.